About Neck-Related Plymouth Arm Pain

chiropractic FOR NECK-RELATED ARM PAIN RELIEF

No other spine problem gives more clinical challenge than neck, shoulder and arm pain (radiculopathy). The cause of arm pain (aka cervical spine radiculopathy) is most commonly a herniated cervical disc, degenerative disc disease resulting in spinal stenosis, or a combination of the two problems. Arm pain radiculopathy follows the course of a spinal nerve in the cervical spine / neck that is compressed or chemically inflamed. Knowing the where the arm pain is in the arm and/or hand/fingers directs the doctor to the identity of the level of the spine where the problem starts.

SYMPTOMATOLOGY

Let's start by viewing spine conditions that are common causes of neck, shoulder and arm pain. We will compare the problem areas to normal spine levels to aid your understanding of the spine condition causing the arm pain.

First is a case of a 35 year old female with bilateral arm pain, much worse in the left arm, and severe headaches. The x-ray study and MRI of this patient's spine are here.

Figure 1 shows the cervical spine, or neck, from a side view. At the arrow notice how the vertebra is moved backward on the vertebra below it. This is called retrolisthesis subluxation and occurs because the intervertebral disc between the vertebrae has been torn and sprained to the point that it can no longer hold the vertebrae in normal alignment. Such malpositioning of the vertebra is a clue to the possibility of a disc herniation and disruption inside of the disc to allow the excessive movement of one vertebra on its adjacent segment. Such movement is termed instability.

Figure 2 shows the neck in a forward flexed position with the chin on the chest. Note at the arrow that the vertebra that was positioned back on the vertebra below in Figure 1 is now moved forward to a normal position. This again shows the instability of the spine due to tearing and sprain of the disc between the vertebrae. This is an example of marked instability.

Figure 3 is an xray taken with the patient looking up to the ceiling, or placing the neck into extension motion. Note that the vertebra at the arrow has moved backward on the vertebra below, again demonstrating instability of the intervertebral disc. Compare this vertebra position at the arrow to the same position shown in Figure 2 in which the vertebrae are in normal alignment.

Figure 4 is called an oblique x-ray of the neck and this view allows the reader to look into the nerve openings and note any diminished size of one opening to other openings in the cervical spine. In this case, at the arrow, note the narrow front to back size of that opening compared to adjacent levels. This noted level is the level of backward position of one vertebra on the one below. This narrowing compressed the nerve passing through it and sometimes this narrowing is termed minor stenosis.

Figure 5 is a lateral MRI view of the spine shown on x-ray in Figures 1-4. At the arrow is the disc herniation, in this case at the C5-C6 level, where we see the instability and backward movement of the C5 vertebra on C6 below it. This disc herniation is also shown in Figure 6 below in an axial or cross cut view through the disc space at C5-C6 showing the disc herniation compressing the nerve to cause the arm pain that this patient complains of. (See the large arrow.)

Note in Figure 6, at the small arrow, the white dense material within the disc herniation; this signifies active inflammation within the disc and such inflammation is considered a source of pain. Also note that this disc herniation also contacts the spinal cord as shown at the yellow arrow.

HOW DOES THE COX TECHNIC SYSTEM OF SPINAL MANIPULATION BENEFIT PATIENTS WITH NECK, SHOULDER AND ARM PAIN?

Please consider some basic facts and findings.

Cervical radiculopathy is relieved in 91% of cases by manual physical therapy, traction, and exercises. (1)

Surgery does not consistently alter the natural history of cervical spine myelopathy.

It is reported that follow-up of 7 years post surgery shows only 1/3 of the patients were improved. (4)

King (5) showed that at a 6 month follow up of 62 myelopathy patients, surgery yielded no benefit over non-surgical care for these myelopathy patients. Surgery is no better than non-surgical care for myelopathy patients.

SUCCESS OF THE COX SYSTEM OF SPINAL MANIPULATION

Kruse (6) presents a 51 y/o woman with 2 years of left arm pain. Her MRI shows a C5-C6 herniated disc. She had tried P.T., home traction, exercise, and medication no help. Cox Technic Flexion-Distraction produced relief for her after the first treatment. She was treated for 3 visits a week for 2 weeks, then every 2 weeks for total of 24 visits over 6 months. At one year follow up, she was symptom free with normal neurological status.

Gudavalli et al (7) reported the relief of the Cox Technic system of spinal manipulation for spinal stenosis of the cervical spine. Cox Technic Flexion Distraction and Decompression manipulation with physiotherapy modalities showed good subjective and objective clinical outcomes for a C6-C7 disc herniation causing severe neck and upper back pain and radiating left arm pain to the fingers in a 33 year old man. The C6-C7 herniated disc was MRI confirmed. It caused severe foraminal stenosis. The patient was treated 15 times over a 10 week period for relief of his symptoms. At 2 year follow-up, he was stable.

Kruse (8) reported on cervical spinal stenosis with arm pain and the relief following administration of the Cox Technic system of spinal manipulation:

Time of Care: 5 weeks, 3 treatments a week, total of 19 visits over 5 months

Outcome at 8 weeks:

Normal reflexes and sensation

negative Hoffman reflex

VAS improved from 7 to 2

no arm or neck pain

Kruse (9) again reported on a severe case of neck, shoulder and arm pain relieved with the Cox Technic System spinal manipulation in a 34 year old female with severe neck, shoulder, arm pain of several months’ duration. Her diagnosis was a C2-C3 blocked vertebrae with occipitalization of atlas and degenerated discs. Flexion- Distraction manipulation gave complete resolution of symptoms after 8 treatments over 2 months.

Cervical radicular arm pain often results from a herniated cervical disc or degenerative disc disease with spinal stenosis or a combination of the two. (19, 20)

Upper-extremity pain, paresthesia or numbness, weakness, scapular pain, or a combination of these signs and symptoms (21), headaches (22), and neck pain may point to arm pain radiculopathy.

CLINICAL CASES

Let's end this section on the management of neck, shoulder and neck-related arm pain patients with the Cox Technic system of examination, diagnosis and spinal manipulation treatment with a classic example of a cervical disc herniation in Figures 7 and 8 below.

Figure 8 shows the disc herniation seen in Figure 7 in a view looking down upon the disc. See the herniation at the arrow.

The chiropractic management system of Cox Technic Flexion Distraction and Decompression protocols for the examination, diagnosis and treatment of neck pain and arm pain (radiculopathy) patients may be a solution for your neck-related arm pain.

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Our practice at Atiyeh Chiropractic and Functional Neurology focuses on chiropractic wellness as well as relief of pain, especially spine pain and its related conditions. We offer comprehensive care for back pain, neck pain, headaches, shoulder pain, arm pain, leg pain, and injuries to the body from a car accident, sports injury or other cause. Our chiropractic practice respectfully serves the Plymouth area. We pride ourselves on being patient-oriented and active to fulfilling your needs be they about insurance filing or appointment making or your health and healing. We administer individualized treatment plans to accommodate your exact needs. If you're in need of a chiropractor in the Plymouth area, contact us today!